808.45 Referrals to the Medical Exemption Unit (MEU) (FAM)

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Refer individuals to the Medical Exemption Unit (MEU) whenever an individual:

• claims an exemption from the New Hampshire Employment Program (NHEP) due to the individual’s or household member’s health condition that is expected to last longer than 6 weeks;

• claims a limitation in NHEP participation due to the individual’s or household member’s health condition that is expected to last longer than 6 weeks; or

• requests a Financial Assistance to Needy Families (FANF) hardship extension due to the individual’s or household member’s health condition.

If the health condition is expected to last less than 6 weeks and the individual is not requesting an exemption or a FANF hardship extension, do not refer the case to the MEU; NHEP can monitor short-term impairments and place the individual in an Interim Activities activity. All approved activities must take into account the individual’s temporary limitations.

Medical Exemption Packet

A Medical Exemption packet includes:

• BFA Form 752A, Authorization for Release of Protected Health Information for FANF Financial Assistance; and

• BFA Form 752, Healthcare Provider Statement of Abilities for FANF Financial Assistance (to request exemption based on the individual’s health condition); or

• BFA Form 752HH, Healthcare Provider Statement of Necessary Care for a FANF Household Member (to request exemption based on the household member’s health condition).

BFA Form 752

Individuals claiming an exemption from NHEP, a limitation in NHEP participation, or a FANF hardship extension due to their own health condition must have an authorized healthcare provider provide the information requested on BFA Form 752, Healthcare Provider Statement of Abilities for FANF Financial Assistance.

BFA Form 752HH

Individuals claiming an exemption from NHEP, a limitation in NHEP participation, or a FANF hardship extension due to the necessary care of a household member with a health condition must have an authorized healthcare provider provide the information requested on BFA Form 752HH, Healthcare Provider Statement of Necessary Care for a FANF Household Member. See Section 808.07, Verification of Exemptions, for information about this type of exemption, including which types of caregiving relationships qualify.

BFA Form 752A

BFA Form 752A, Authorization for Release of Protected Health Information for FANF Financial Assistance, serves two purposes:

• The front side of this document informs FANF applicants and recipients (and their household member, if applicable) of the process that must be followed when claiming a medical exemption;

• The back side of this document, when properly filled out and signed by a healthcare provider’s patient, allows for release of protected health information from a healthcare provider to DHHS, including contract staff.

All individuals requesting a medical exemption should be given BFA Form 752A; however, some healthcare providers may prefer to have their patients fill out the healthcare providers’ own release document in order to share the health information that is requested on BFA Form 752 or 752HH.

The back of BFA Form 752A is for the healthcare provider and does not need to be returned to the MEU. However, give a copy of the front page of BFA Form 752A to the individual because it contains important information about the medical exemption process, and the original of this form is going to go to the healthcare provider.

Exception: For an individual requesting a FANF hardship extension only, if the information requested on BFA Form 752 or BFA Form 752HH is less than 4 months old and the individual is still in exempt status for his or her health condition, do not make the individual complete a new Medical Exemption packet. If current verification on file is more than 4 months old or if the current verification is less than 4 months old but the exemption for the health condition has expired, the individual requesting a hardship exemption must provide a new Medical Exemption packet.

The request for a FANF hardship extension or an exemption from or limitation in NHEP participation will be denied, if:

• the authorized healthcare provider fails to return the information requested on BFA Form 752 or BFA Form 752HH, even after the MEU attempts to help get the information; or

• the applicant fails or refuses to cooperate with the MEU.

Healthcare providers authorized to provide the information requested on BFA Form 752 or 752HH are currently licensed:

• Physicians;

• Physician Assistants;

• Advanced Practice Registered Nurses;

• Psychologists (board certified);

• Pastoral Psychotherapists;

• Alcohol and Drug Counselors (Master Licensed Alcohol and Drug Counselors only);

• Independent Clinical Social Workers;

• Clinical Mental Health Counselors; and

• Marriage and Family Therapists.

Participant Status After Referral to the MEU

Applicants

Applicants claiming a medical exemption from NHEP work requirements will be considered exempt until the MEU receives the information requested on BFA Form 752 or BFA Form 752HH and is able to determine the individual’s ability to participate in NHEP. Applicants have 10 days from the date of referral to have an authorized healthcare provider submit the information requested on BFA Form 752 or 752HH. If the applicant fails to provide these documents within the required time period, the MEU codes the applicant as a mandatory participant in NHEP.

Recipients

Mandatory or voluntary participants in NHEP who claim an exemption to work requirements due to a health condition will retain their status of mandatory or voluntary during the period of time the MEU is awaiting the return of needed documentation and making a determination on the recipient’s claim for exemption. Participants must continue to comply with NHEP. Failure to comply with NHEP during the MEU determination process is cause for progressive sanctioning or denial or closure of the FANF hardship extension if the individual is applying for or in a FANF hardship extension.

Individuals who are currently exempt from participation requirements due to a health condition will be referred to the MEU at their next regularly scheduled redetermination and must re-document the health condition if, at that time, the required health information, as listed on BFA Form 752 or BFA Form 752HH, does not provide current information clearly documenting a current health condition that requires an exemption.

Medical exemptions must be re-documented at least every 6 months unless otherwise indicated by the authorized healthcare provider.

Claim Status After Referral to the MEU

If not requesting a FANF hardship extension, once the information requested on BFA Form 752 or BFA Form 752HH is returned to the MEU and the healthcare provider has indicated that:

• the individual is partially or fully able to participate in work or work-related activities, the MEU will enter this information into New HEIGHTS and the individual will be referred to NHEP if the individual is not currently participating in NHEP; or

• the individual is totally unable to participate in work program activities, the MEU will enter this information into New HEIGHTS.

Note: If this is at least the second time the individual is asking for an exemption for this condition or if the authorized healthcare provider indicates that this condition will last at least 12 months:

• Individuals making a claim about their own health condition: The individual must provide proof to the Family Service Specialist (FSS) within 30 days that the individual has applied for other benefits for which he or she is potentially eligible, such as Supplemental Security Income (SSI), Social Security Disability Income (SSDI), Veteran’s Administration (VA) benefits, Aid to the Permanently and Totally Disabled (APTD), or Aid to the Needy Blind (ANB).

• Individuals making a claim about the health condition of a household member: If the household member is a member of the AG, then the individual making the claim must provide proof within 30 days that this household member has applied for other benefits for which he or she is potentially eligible.

See PART 317, DEVELOPING POTENTIAL SOURCES OF INCOME, for further information about the requirements on applicants, recipients, and assistance group members for developing potential sources of income as a condition of eligibility.

If requesting a FANF hardship extension due to a health condition, the MEU will determine the individual’s ability to participate in NHEP work activities based on the information provided by the healthcare provider. The MEU will note this determination in the case notes for the District Office Supervisor’s review and decision on the hardship request.

References: He-W 606.32; He-W 637.04; RSA 167:82, II; RSA 167:91